Health and Demographic Surveillance System
Lead Research Organisation:
London School of Hygiene and Tropical Medicine
Department Name: UNLISTED
Abstract
The HDSS has provided data to most PIs and students in The Unit who have implemented world leading research aimed at saving lives and improving health across the world. Several outputs have been published from the HDSS from its inception across the three sites. This platform tries to achieve and ensures support to other platforms/themes and sub-themes across the Unit and has supported a number of cluster randomized trials on malaria interventions, trials on pneumococcal conjugate vaccine (PVS), studies on trends in vaccine-associated behavior and Inter-generational follow-up (biobank in Keneba that follows families)for nutrition and planetary health studies among others.
Presently the HDSS is trying to achieve a strengthened system as per its EDC system for data collection, link health facility data with HDSS data – Electronic Medical Record System in selected facilities and increase visibility and collaborative links. This is important because it will enable easy access to curated, accurate, consistent and improved data quality, while maintaining stability thus creating visibility and more collaborations both internally and externally.
Presently the HDSS is trying to achieve a strengthened system as per its EDC system for data collection, link health facility data with HDSS data – Electronic Medical Record System in selected facilities and increase visibility and collaborative links. This is important because it will enable easy access to curated, accurate, consistent and improved data quality, while maintaining stability thus creating visibility and more collaborations both internally and externally.
Technical Summary
The Unit maintains three Health and Demographic Surveillance Systems in Basse, Farafenni, and West Kiang. The HDSS collects data on vital events, namely births, deaths, migrations, pregnancy, educational level, ethnicity, vaccination status, socio economic status and cause of death (through Verbal Autopsies) using the electronic data capture (EDC) method via RedCap application. We aim to provide baseline data, sampling frame and identify clinical cases/study subjects to scientists for community-based research. We also provide a denominator for estimating impact studies, generate longitudinal information on the health of the population and provide quantitative evidence for scientific investigations as well as monitor demographic and mortality trends in populations.
Organisations
- London School of Hygiene and Tropical Medicine (Lead Research Organisation)
- Muhimbili University of Health and Allied Sciences (Collaboration)
- Eduardo Mondlane University (Collaboration)
- University of Ibadan (Collaboration)
- NEWCASTLE UNIVERSITY (Collaboration)
- Gates (Collaboration)
- University of California, Los Angeles (UCLA) (Collaboration)
- University of Cape Town (Collaboration)
- University of the Witwatersrand (Collaboration)
- University of Oxford (Collaboration)
- St Georges Hospital (Collaboration)
- University of Botswana (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- Ludwig Maximilian University of Munich (LMU Munich) (Collaboration)
- Medical Research Council (MRC) (Collaboration)
Publications
Agboghoroma O
(2022)
Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study
in Journal of Endocrinology, Metabolism and Diabetes of South Africa
Antimicrobial Resistance Collaborators
(2024)
The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis.
in The Lancet. Global health
Antimicrobial Resistance Collaborators
(2022)
Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis.
in Lancet (London, England)
Armitage E
(2024)
Streptococcus pyogenes carriage and infection within households in The Gambia: a longitudinal cohort study
in The Lancet Microbe
Bittaye SO
(2022)
Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia.
in Malaria journal
Boté-Casamitjana A
(2024)
Evaluating the sensitivity and specificity of Determineâ„¢ HIV-1/2 rapid test using a 0.01M phosphate-buffered saline produced at the Medical Research Council Unit The Gambia for the diagnosis of HIV.
in Transactions of the Royal Society of Tropical Medicine and Hygiene
Brindle HE
(2022)
Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam.
in EcoHealth
Camirand-Lemyre F
(2023)
Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19.
in JAMA network open
Citarella BW
(2024)
Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms.
in Heliyon
| Description | Advice provided to Gambian Medical and Dental Council |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | This has informed the plans that the MDCG are making to improve the regulatory and disciplinary structures for doctors in the UK. |
| Description | CSD Guidelines |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | We have undertaken a number of internal clinical audits showing that we have improved care to the patients we see. For instance, we now provide standardised care to patients with hyperthryoidism and have greater number of our heart failure patients on treatments shown to improve mortality outcomes. |
| Description | Contributing to Knocking Out AMR workshop |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a guidance/advisory committee |
| URL | https://microbiologysociety.org/our-work/knocking-out-antimicrobial-resistance.html |
| Description | Examining for MDCG |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | We enable the Medical and Dental Council to ensure that practitioners registered in The Gambia have reached the appropriate levels of competence. |
| Description | International Officer for the Faculty of Internal Medicine of the West African College of Physicians. |
| Geographic Reach | Africa |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | National Action Plan for AMR - Workshop |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Impact | This resulted in the development of a National Action Plan which has a coherent section addressing research needs and opportunities. |
| Description | National Patient Safety Training |
| Geographic Reach | National |
| Policy Influence Type | Contribution to new or improved professional practice |
| Impact | Doctors have been trained to think systematically about the risks patients face when undergoing health care and how to reduce this risk. This should improve the quality of care and reduce poor practice at the national teaching hospital. |
| Description | Support to Medical and Dental Council of The Gambia: AIUWA Accreditation Process |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This was partly a training exercise, in that we were being trained to contribute to the regulatory processes in The Gambia. We will be asked to be involved in future accreditations. Also it has enabled the Council to ensure that all medical practitioners in country are properly trained. |
| Description | Training day for residents |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Title | Electronic Medical Record System |
| Description | This database is the medical record system for the CSD clinics in Fajara and Basse. It is also used for some data collection in Keneba. It contains the clinical details of care provided within the clinics - including all outpatient and inpatient care, lab investigations and prescribing data. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2019 |
| Provided To Others? | No |
| Impact | We have been able contribute data from the system to a number of collaborative papers, as well as publishing our own clinical case series. |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | Eduardo Mondlane University |
| Department | Faculty of Medicine |
| Country | Mozambique |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | Muhimbili University of Health and Allied Sciences |
| Department | School of Medicine |
| Country | Tanzania, United Republic of |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Botswana |
| Department | School of Medicine |
| Country | Botswana |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Cape Town |
| Department | Faculty of Health Sciences |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of Ibadan |
| Department | Faculty of Medicine |
| Country | Nigeria |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | AAREN (African Anticoagulation Research and Education Network |
| Organisation | University of the Witwatersrand |
| Department | Medical School Witwatersrand |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | We contributed data, review of abstracts and planned publications, research ideas for potential grant applications. |
| Collaborator Contribution | They have contributed data, have written joint papers and abstracts and have contributed to a grant application based on our idea for which we are still waiting for a response. |
| Impact | The protocol was published here: Mwita JC, Damasceno A, Chillo P On behalf of AAREN Investigators, et al Vitamin K-dependent anticoagulant use and level of anticoagulation control in sub-Saharan Africa: protocol for a retrospective cohort study BMJ Open 2022;12:e057166. doi: 10.1136/bmjopen-2021-057166 The data has been presented at both the ECSACOP and WACP annual meetings as posters / oral presentations. The paper is being finalised for submission. We have an open grant application in progress which is not yet reviewed. Mwita JC, Francis JM, Pillay C, et al. Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa. J Thromb Thrombolysis 2024; published online March 13. DOI:10.1007/s11239-023-02928-1. |
| Start Year | 2022 |
| Description | ADILA |
| Organisation | St Georges Hospital |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | We are working together to contribute our antibiotic prescribing data to this study. |
| Collaborator Contribution | Our partner will analyse the data and return advice and information to us to help us improve our prescribing. |
| Impact | Outputs awaited |
| Start Year | 2023 |
| Description | AMR work with Newcastle Medical school |
| Organisation | Newcastle University |
| Department | Newcastle University Medical School |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We have hosted medical students from Newcastle University in 2022 and again this year. They carry out a co-created project to look at antibiotic use in humans and animals to contribute to the AMR data we have from The Gambia. |
| Collaborator Contribution | They send 2 medical students to carry out a project and provide funding to cover their transport / accommodation / stipend costs and bench fees. |
| Impact | N/A yet. |
| Start Year | 2022 |
| Description | GRAM |
| Organisation | University of Oxford |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We are preparing our the collaboration agreement. We will share microbiology data as well as associated clinical metadata to be included in the Global Burden of Diseases work on AMR. We have shared data from 2019-2023. |
| Collaborator Contribution | They will analyse the data as part of the international study. |
| Impact | Sartorius, B. et al., 2023. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. The Lancet Global Health 0. https://doi.org/10.1016/S2214-109X(23)00539-9 Murray, C.J.L., et al., 2022. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 399, 629-655. https://doi.org/10.1016/S0140-6736(21)02724-0 Naghavi M, Vollset SE, Ikuta KS, et al. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. The Lancet 2024; 404: 1199-226. |
| Start Year | 2022 |
| Description | ISARIC |
| Organisation | University of Oxford |
| Department | Nuffield Department of Medicine |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We contributed data to the ISARIC database. The data comprised structured extractions of real clinical data from patients who were treated for COVID-19. |
| Collaborator Contribution | They have analysed the data in combination with data from many other centres and have begun to publish papers about the data. Currently about how the data can be used to develop AI systems. |
| Impact | Multi-disciplinary: Clinical medicine, Engineering, Epidemiology Merson L, Duque S, Garcia-Gallo E, et al. Optimising Clinical Epidemiology in Disease Outbreaks: Analysis of ISARIC-WHO COVID-19 Case Report Form Utilisation. Epidemiologia 2024; 5: 557-80. Citarella BW, Kartsonaki C, Ibáñez-Prada ED, et al. Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms. Heliyon 2024; 10. DOI:10.1016/j.heliyon.2024.e29591. |
| Start Year | 2022 |
| Description | M72 Epi study |
| Organisation | Gates |
| Country | United States |
| Sector | Private |
| PI Contribution | Site PI for a multi-site epi study |
| Collaborator Contribution | Sponsor for the study |
| Impact | None yet |
| Start Year | 2022 |
| Description | Oxford University Clinical Research Unit Vietnam |
| Organisation | University of Oxford |
| Department | Oxford University Clinical Research Unit Vietnam (OUCRU) |
| Country | Viet Nam |
| Sector | Academic/University |
| PI Contribution | Our team member Behzad Nadjm was formally at OUCRU. He has continued to collaborate, supervising PhD students and finalising papers for publication. |
| Collaborator Contribution | They previously employed Behzad Nadjm. |
| Impact | doi: 10.1016/S2666-5247(22)00338-X doi: 10.1038/s41598-022-27084-z doi: 10.1007/s10393-022-01611-w doi: 10.1016/S2666-5247(22)00181-1 doi: 10.1186/s12936-022-04294-4 doi: 10.3389/fpubh.2022.893200 |
| Start Year | 2023 |
| Description | PaTS / RECOVERY |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have been involved in the discussions around the design and running of the PaTS trial. We have provided clinical care to patients with COVID-19 including those in the study. We have referred patients to join the study as participants. |
| Collaborator Contribution | They have provided staff to the ward as well as clinical time. They have provided equipment, drugs, diagnostics needed to sustain COVID-19 care on the ward. |
| Impact | http://dx.doi.org/10.18203/2349-3259.ijct20230048 |
| Start Year | 2022 |
| Description | Spycats |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have provided clinical care to the participants of the study - this was essential to the safe running of the study. |
| Collaborator Contribution | They designed, obtained funding and ran the study. They have also contributed clinical time to us. |
| Impact | None yet. |
| Start Year | 2022 |
| Description | TB Sequel II |
| Organisation | Ludwig Maximilian University of Munich (LMU Munich) |
| Country | Germany |
| Sector | Academic/University |
| PI Contribution | MRC is one of the clinical sites and Prof Sutherland is the site-PI and work package lead for host immunological analysis |
| Collaborator Contribution | LMU is the lead PI institution |
| Impact | None yet as the project has only just begun |
| Start Year | 2023 |
| Description | TBVAC-HORIZON |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Site PI |
| Collaborator Contribution | 30 other sites contributing to development of novel TB vaccines |
| Impact | None to date |
| Start Year | 2023 |
| Description | UCLA / MRCG quality improvement projects |
| Organisation | University of California, Los Angeles (UCLA) |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | We have worked with the clinical microbiology team from UCLA on a number of quality improvement projects. This year, they have sent us a medical student for 6 months to lead a series of quality improvement projects. We have provided him with support and supervision, as well as the ideas of what our problems are that he can help us with. |
| Collaborator Contribution | The student has been involved in 7 different projects, several have been resolved with successful outcomes. Others are ongoing. We hope to start two audit projects before he leaves that will help us investigate outcomes and should lead to publications. He has also worked with the molecular biology lab to develop a fungal PCR assay and has brought more direct financial support to that project. We have established several new processes that have improved labelling and transmission of samples to the labs. |
| Impact | N/A |
| Start Year | 2022 |
| Description | Vaccine trials |
| Organisation | Medical Research Council (MRC) |
| Department | MRC Unit, The Gambia |
| Country | Gambia |
| Sector | Public |
| PI Contribution | We have provided clinical care for participants of multiple vaccine trials - including Serum Institute of India Yellow fever licencing trial, Matisse (Pfizer sponsored RSV maternal vaccination study), Microneedle Measles / Rubella phase 1 study, GAPS (Pertussis maternal vaccination study), HPV (Human Papillomavirus vaccine study), Novel Oral poliovirus 2 vaccine licencing study. Without this care, these studies could not have proceeded in our setting. |
| Collaborator Contribution | They obtained designed, obtained funding and ran the studies. |
| Impact | 10.1186/s13063-022-06493-5 |
| Start Year | 2022 |
| Description | Evaluation of two point-of-care screening tests for TB |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | International symposium presented at the Union World Conference on Lung Health, Paris, November 2023. Presentation was our data from a multi-site trial on evaluation of two novel screening test for TB |
| Year(s) Of Engagement Activity | 2023 |
| Description | Informational videos for clinics - to address how the clinics work and research use of data |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | 2 Videos were created - one for the Keneba clinic and one for the Fajara clinic. The videos describe how the clinics work, what is done with blood samples and why we might take them and what is done with clinical data - particularly how it can be used anonymously for quality improvement or (with ethics permission) for research. These videos are played in the clinic waiting areas in Keneba and Fajara potentially reaching up to 300 people per working day. |
| Year(s) Of Engagement Activity | 2022 |